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commercial health insurance in the state. Allowing the Medicaid group to not receive the fullMedicaid benefits package was expected to save money to cover more parents in the program.Permission was given for Medicaid funds to be used to cover these parents if SCHIP funds runout. 215Expanding Coverage through Reduced Medicaid Benefits — UtahUtah received an 1115 waiver in February 2002 to extend a limited Medicaid benefits packageto low-income people that were not previously eligible, including childless adults. The state cutservices and raised co-pays for some enrollees to fund the expansion, which was the first timethis was done with an 1115 waiver. This is the prototypical HIFA option, though the waiver isnot technically considered a HIFA waiver. The HIFA initiative, introduced in 2001, allowsfinancing of a waiver by methods that were already allowed under 1115 waivers, but alsoprovides several new ways of financing waivers (since waivers must be budget-neutral), such asreducing coverage, increasing cost-sharing requirements, and capping enrollment for the newlyeligible expansion groups. 216 One way that the Utah 1115 waiver differs from a HIFA waiver isthat the state was allowed to cut some benefits for mandatory populations as well as for optionaland expansion groups. 217Several other states have received HIFA-type waivers as well, but Utah is a good example ofthe major changes that can be implemented by increasing flexibility with benefits and costsharing,as most of the other states have not reduced Medicaid benefits for existing enrollees orincreased cost-sharing. 218 Utah’s waiver, called the Primary Care Network (PCN), expandsMedicaid to uninsured adults aged 19 and older with incomes up to 150 percent FPL (originallyestimated to be 25,000 people). In 2003, an amendment to the waiver was approved to providea premium assistance option called Covered at Work (CAW), which subsidizes the employee’sportion of employer health insurance for up to five years. The waiver made changes such asreducing benefits, instituting an enrollment fee of $15 to $50 for people in the expansionpopulations and increasing hospital admission co-payments from $100 to $220. 219Benefits that were reduced for the mandatory population include eliminating non-emergencytransportation and reducing mental health benefits. Benefits that were reduced for the optionalpopulation include cuts in dental, vision and speech services, and in the number of visits tophysical therapists, chiropractors and psychiatrists. The PCN benefit package focuses onpreventive care and does not include prescription drugs or inpatient hospitalization, however,the state negotiated a certain amount of donated care from hospitals and specialists to helpthose who need these services. 220 No benefits are reduced for children, pregnant women, thedisabled, or the elderly. 221 The regular state plan Medicaid population has a maximum out-ofpocketexpense cap of $500 per year; this cap is $1,000 for the PCN waiver population.As of December 31, 2004, 17,643 people were considered “State Plan Eligibles” and wereenrolled in Utah’s reduced benefit plan. These are people who are eligible for Medicaid throughTransitional Medical Assistance, Temporary Assistance to Needy Families or Medically Needy(who are not elderly, blind, or disabled). This does not include pregnant women, children, thedisabled or the elderly, since benefits were not cut for these groups and thus they remain inwhat Utah terms “traditional Medicaid.” An additional 18,910 were enrolled in the Primary CareNetwork (the expansion population who were previously uninsured and who receive primarycare benefits only), 67 people were enrolled in Covered at Work, and 82 people were enrolled inanother demonstration population consisting of high-risk pregnant women with assets over$5,000 (the maximum allowed in the state’s traditional Medicaid program). 222C-7